Research Roundup

Cardiomyopathy develops early

Contrary to claims in medical textbooks, children who develop cardiomyopathy are more likely to do so in the first year of life than later in childhood, according to a study led by pediatric cardiologist Steven Lipshultz and published in the April 23 New England Journal of Medicine.

The study of nearly 500 children at 38 sites nationwide also finds that gender, race, and region play a role in determining who develops the disease. Textbooks assert that it is highly unusual for children to develop cardiomyopathy--an uncommon and potentially devastating disease in which children have weak heart muscle or too much heart muscle--before they are teenagers. That couldn't be further from the truth, says Lipshultz, chief of pediatric cardiology at Golisano Children's Hospital at Strong.

As director of its Children's Heart Center, Lipshultz oversees the care of more than 500 children who have the disease, some of whom have come from as far away as Pakistan.

"This study shows that expert opinion from around the world is not a viable substitute for examining the data and that children are about 10 times more likely to develop cardiomyopathy during their first year of life than ages 2 to 18 combined," Lipshultz says.

Pupil size matters

Exactly how a person's eyes respond to low levels of light is more crucial than doctors have thought in determining who is a good candidate for laser vision correction surgery, according to research by Scott MacRae, professor of ophthalmology and visual science.

MacRae is part of a team that has used a technology known as adaptive optics to discover dozens of previously unknown subtle imperfections in the eye. His research shows that generally the larger a patient's pupils, the more likely that person is to have a problem with laser vision correction.

MacRae recommends that doctors treating patients with large pupils consider creating an especially large treatment zone; the problem is particularly critical if a person is extremely near-sighted.

"This is not a problem for most people," says MacRae, "but as the procedure becomes more common, we have to make sure that we remain vigilant to protect and enhance people's eyesight."

Honesty may be best medicine

In light of more awareness of medical errors and skyrocketing malpractice insurance rates, physicians need to rethink the way they talk to patients, says James Woods, professor and chair of the Department of Obstetrics and Gynecology, in his new book What Do I Say? Communicating Intended or Unanticipated Outcomes in Obstetrics.

Written for health care providers, the book asserts that being honest and forthright is best and provides a roadmap for discussing bad news with patients and families.

The book grew out of a series of nationwide speaking engagements in which Woods and coauthor Fay Rozovsky, senior vice president, Marsh National Health Care Practice, began educating doctors about the consequences of poor communication and inadequate informed-consent procedures in hospitals.

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